A 65-year-old man was referred to The Johns Hopkins Hospital Oncology
Service for treatment of acute myelogenous leukemia. On admission, he had
fevers, neutropenia, and erythematous papular lesions of the face and left
antecubital fossa. Acinetobacter was cultured from
his blood. Treatment included vancomycin, ciprofloxacin, and a 3-week course
of gentamicin at a dose of 1.7 mg/kg intravenously every 8 hours. Predose
and peak postdose gentamicin levels were checked on 4 occasions during treatment
and never exceeded the therapeutic range, which is less than 2.5 mg/L within
30 minutes predose and less than 10 mg/L 1 hour postdose. On the fourth day
of broad-spectrum antibiotic therapy, induction chemotherapy was begun with
cytarabine, daunorubicin, and etoposide. During this period the patient developed Aspergillus pneumonia requiring treatment with amphotericin
B.